Clinicopathological features of clinical methotrexate-related lymphoproliferative disorders
Clinicopathological features of clinical methotrexate-related lymphoproliferative disorders
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DOI：
10.1080/10428194.2019.1585841
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发表时间：
2019-08-24
影响因子：
2.6
通讯作者：
Kizaki, Masahiro
中科院分区：
文献类型：
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作者：
Tokuhira, Michihide;Saito, Shuntaro;Kizaki, Masahiro
甲氨蝶呤（MTX）是治疗自身免疫性疾病（AD），特别是类风湿性关节炎的有效药物之一。最近的研究表明，MTX应立即停止与AD患者发生淋巴组织增生性疾病（LPD）。然而，由于MTX停药后LPD迅速消退，因此无法进行活检进行诊断，从而使临床MTX-LPD（c-MTX-LPD）难以诊断。在这项研究中，在28例c-MTX-LPD患者中，7例在可疑LPD（s-LPD）消退后发生了经证实的LPD（p-LPD），其中6例为霍奇金淋巴瘤。7例p-LPD？+？患者中有4例死亡，而所有p-LPD患者？活下来了提示p-LPD的临床表现包括发热、血清C-反应蛋白水平升高和可溶性白细胞介素-2受体水平升高。抗AD药物似乎不影响p-LPD发展的发病机制。从s-LPD消退时起3年后未观察到P-LPD。
Methotrexate (MTX) is one of the potent drugs for autoimmune diseases (ADs), especially for rheumatoid arthritis. Recent studies suggest that MTX should be immediately withdrawn when patients with AD develop lymphoproliferative disorder (LPD). However, biopsy cannot be performed for diagnosis because LPD regresses quickly after MTX withdrawal, thus making clinical MTX-LPD (c-MTX-LPD) challenging to diagnose. In this study, among the 28 patients with c-MTX-LPD, seven developed a proven LPD (p-LPD) after suspicious LPD (s-LPD) regression, six of which were Hodgkin lymphoma. Four of seven patients with p-LPD?+?died, whereas all patients with p-LPD? survived. The clinical manifestations indicative of p-LPD include fever, elevated serum C-reactive protein level, and soluble interleukin-2 receptor level. Anti-AD drugs did not appear to affect the pathogenesis of p-LPD development. P-LPD was not observed after 3 years from the time of s-LPD regression.